Journal of Cytology
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IMAGES IN CYTOPATHOLOGY  
Year : 2021  |  Volume : 38  |  Issue : 1  |  Page : 52-53
Cytodiagnosis of spermatic granuloma


Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

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Date of Submission28-Jul-2020
Date of Decision17-Sep-2020
Date of Acceptance28-Oct-2020
Date of Web Publication04-Jan-2021
 

How to cite this article:
Negi L, Mardi K, Sharma S, Negi L. Cytodiagnosis of spermatic granuloma. J Cytol 2021;38:52-3

How to cite this URL:
Negi L, Mardi K, Sharma S, Negi L. Cytodiagnosis of spermatic granuloma. J Cytol [serial online] 2021 [cited 2021 Mar 5];38:52-3. Available from: https://www.jcytol.org/text.asp?2021/38/1/52/306115




Epididymis is a site for a variety of non-neoplastic and neoplastic lesions, predominantly the former.[1] Non-neoplastic nodular lesions in the epididymus can be due tuberculous granulomatous inflammation, cystic nodules, spermatoceles, encysted hydrocele, filarial infection, sperm granulomas, and adenomatous hyperplasia.

Sperm granuloma is an exuberant foreign body reaction to extravasated sperm and occurs in 42% of patients after vasectomy[2] and accidentally found in 2.5% of routine autopsies. It presents as a painless nodule in the epididymus, mimicking a testicular tumor.[3]

Cytological features of spermatic granuloma are quite specific. A very few case reports have been described in the literature. We report fine-needle aspiration cytology findings in a case of spermatic granuloma in a 46-year-old male who presented with painless paratesticular nodule since 5-6 months. There was no history of trauma or previous surgery/vasectomy. Clinically, the case was diagnosed as epididymal nodule. Ultrasonography of the scrotum was suggestive of adenomatoid tumor.

Fine needle aspiration of the left epididymal nodule was done. Giemsa stained smears showed abundant spermatozoa and sperm heads, numerous macrophages with phagocytosed sperm head, [Figure 1] few clusters, and group of benign epithelial cells of epididymus. Mixed inflammatory cells, multinucleated giant cells [[Figure 1], inset], and occasional epithelioid cell granulomas [Figure 1] were also seen. Ziehl-Neelsen stain was done for the demonstration of tubercle bacilli was negative. Cytological diagnosis of epididymal spermatic granuloma was given.
Figure 1: Smears showing abundant spermatozoa, sperm heads, and epithelioid cell granuloma, Inset shows macrophage with phagocytosed sperm head and multinucleated giant cells (Giemsa, 40×)

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Sperm granuloma was first described by Grunberg in 1926.[4] They can range in size from microscopic focus to up to 4 cm. However, most of them are less than 1 cm. Although most spermatic granulomas are asymptomatic, some may manifest as a palpable nodule.

Spermatic granuloma is a non-tuberculous granulomatous lesion. The granulomatous reaction may be chemical in nature since the spermatozoa contain an acid-fast lipid mycolic acid similar to the lipid that is found in tubercle bacilli.[5]

Gupta et al. studied 228 cases of epididymal nodule in India with 5.3% incidence of spermatic granuloma.[6] In another study by Shah et al. the incidence of spermatic granuloma was found to be 7.5%.[7] They had usually found spermatic granuloma in patients who have undergone vasectomy.

The important cytological differential diagnosis of spermatic granuloma is tuberculous epididymo-orchitis. The condition was ruled out based on clinical findings, microscopic features, and special stains like Ziehl-Neelsen stain for tubercle bacilli. The other important differential diagnoses is adenomatoid tumor. In adenomatoid tumor, the cells are arranged in dyscohesive sheets with eccentrically pushed nuclei and small central nucleoli.

In conclusion, spermatic granuloma though uncommon should be considered in the differential diagnosis of epididymal nodule. Cytological diagnosis of spermatic granuloma is quite specific and enables rapid diagnosis of epididymal nodule, there by relieving the patient's anxiety and avoiding unnecessary surgical intervention.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Perez-Guillermo M, Sola Perez J. Aspiration cytology of palpable lesions of scrotal content. Diagn cytopathol 1990;6:169-77.  Back to cited text no. 1
    
2.
Mc Donald SW. Cellular responses to vasectomy. Int Rev Cytol 2000;199:295-339.  Back to cited text no. 2
    
3.
Glassy FJ, Mastofi FK. Spermatic granuloma of the epididymus. Am J Clinical Pathol 1956;26:1303-13.  Back to cited text no. 3
    
4.
Taylor JBL. Spermatic granuloma. Br J Urol 1959;31:196-200.  Back to cited text no. 4
    
5.
Berg JW. An acid -fast lipid from spermatozoa. Arch Pathol 1954;57:115-20.  Back to cited text no. 5
    
6.
Gupta N, Rajwanshi A, Srinivasan R, Nijhawan R. Fine needle aspiration of epididymal nodules in Chandigarh, North India: An audit of 228 cases. Cytopathology 2006;17:195-8.  Back to cited text no. 6
    
7.
Shah VB, Shet MT, Lad KS. Fine needle aspiration cytology of epididymal nodule. J Cytol 2011;28:103-07.  Back to cited text no. 7
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Correspondence Address:
Dr. Kavita Mardi
Set No 14, Type VI Quarters, IAS Colony, Meheli, Shimla, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JOC.JOC_133_20

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